Free Birth Control? Depends on the Brand.

Yesterday’s big rollout of the new HHS regulation requiring insurance plans to cover contraception with no copay for insured women was met with a dramatic reaction. Women’s groups celebrated the news, while the usual suspects who fear nothing more than a woman-controlled vagina threw a fit, going as far as to compare women’s improved access to birth control to the attacks of 9/11. In all the fuss, the fact that the new benefit has its limits might have gotten lost. While eventually most American women will get their birth control covered (except for those who work for religious institutions like churches that don’t want to offer it), only women who bought or had a plan renewed on Aug. 1 will begin to have access to co-pay-free birth control. Insured women whose plans renew later will have to wait.

For those women who do have the benefit already, however, be forewarned: Not all birth control is covered. While the HHS website describes the benefit as applying to, “All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity,” “all” is a word that’s subject to interpretation—as I learned yesterday when I waltzed into the pharmacy expecting to not pay a cent but still had to fork over $50 to get my pills. All kinds of birth control are covered—pills, rings, injections, IUDs, diaphragms, emergency contraception—but not all brands. Insurance companies have a lot of leeway within the regulation to refuse to cover certain brands. For brands that have a generic version, the company can choose to only offer the generic for free. For certain brands that don’t have a generic, they can refuse coverage, requiring the patient to get a new prescription for a different brand that is within the company’s parameters.

While these restrictions are a disappointment for women who were hoping that free pills really were going to be hassle-free (women like me!), in the end, it’s probably for the best. One of the major goals of the Affordable Care Act is to rein in exploding health care costs, and one of the best ways to do that is to steer patients from expensive treatments to less expensive ones that work equally as well. It is a little baffling why these restrictions weren’t better-marketed by the Obama administration, however. One of the biggest conservative talking points against the mandate was to find this cheap brand or that and demand that all women simply pay for it out of pocket instead of expecting insurance benefits they pay for to cover it. But it turns out the regulation is set up in such a way as to steer women towards the cheapest option that will work with their bodies. The insinuation that the “government” would be paying for gold-plated slut pills for every American woman is simply false on every level, both because it’s insurance that women buy into that pays for it and because the insurance companies retain the right to cut costs by pushing women towards the least expensive options possible.